Search Results for: stop-loss

Where the Bread is Really Buttered: Insurers’ Q4 Earnings Reports Show Heavy Reliance on Government Business

Posted by

…Share in Medicare Advantage Medicare Advantage enrollment has experienced significant growth; enrollment in the program has more than doubled in the last ten years. Health plans are taking notice of the business opportunity. On its earnings call, UnitedHealth identified the Medicare Advantage program as a key source of their successful financial performance in 2021. However, Humana reported a loss in…

New Data Show Medical Debt Disproportionately Affects the Most Vulnerable Populations

Posted by

…Community Service Society of New York found that 55 hospitals had sued about 4,000 patients for medical debt in that period. Hospitals had engaged in these practices despite receiving millions of dollars in pandemic relief to offset pandemic-related losses. Vulnerable Populations Are Most Affected by Medical Debt New studies shed light on how medical debt disproportionately affects the country’s most…

Questionable Quality Improvement Expenses Drive Proposed Changes to Medical Loss Ratio Reporting

Posted by

By Karen Davenport Under the Affordable Care Act (ACA), insurers must provide rebates to enrollees when their spending on clinical services and quality improvement, as a proportion of premium dollars, falls below a minimum threshold known as the “medical loss ratio” (MLR). Federal regulators have discovered some insurers are gaming the system by misallocating expenses or inflating their spending on…

January Research Roundup: What We’re Reading

Posted by

…among small employers, it is important to note that it may not reflect the rise of level-funded plans, which market a self-funded plan combined with a low attachment point stop-loss policy. Many small employers may not realize that level funded plans are effectively self-funded plans. Over the long term, it will be important for stakeholders to continue monitoring coverage trends…

Insurers are Now Covering At-Home COVID Tests but Implementation Varies

Posted by

…from a health care provider. However, this has not stopped several payers from imposing this requirement (see Table). Meanwhile, some forms also contain explicit warnings about insurance fraud for anyone who submits inaccurate information on their reimbursement request. This, combined with confusion about what exactly they are being asked to attest to, could have a chilling effect on many consumers’…

Adoption of Value-Based, Alternative Payment Models: Where Are We Today and Where Do We Go from Here?

Posted by

…reluctance to adopt these models suggests that they will need greater incentives to transition their practices away from FFS and towards value-based APMs. These could be carrots – such as financial support for the necessary infrastructure or technical assistance – or sticks – such as the threat of loss of network status or reductions in reimbursement rates. Given the political…

December Research Roundup: What We’re Reading

Posted by

…not be required to reconcile premium tax credits on their tax returns. BBB proposes a major change in the marketplace enrollment process by allowing low-income individuals to enroll year-round, whereas enrollment is typically restricted to the annual open enrollment period or special enrollment opportunities that are triggered by certain life events like loss of employer coverage. In addition, the BBB…

Changes to Wellness Programs Suggest Employers are Rethinking Health Promotion

Posted by

…financial incentives for completing the screening. Similarly, 15 percent of large firms and 5 percent of small firms reduced their standards for receiving a financial incentive in health-contingent programs. And while the proportion of employers offering programs to help employees lose weight or stop smoking, or offering other lifestyle or behavioral coaching, remained steady, half of these firms made changes…

November Research Roundup: What We’re Reading

Posted by

…disproportionately in counties that had fewer marketplace insurers in 2018. Counties that gained insurers from 2018 to 2021 were more likely than counties that did not gain insurers during this period to have: a limited number of insurers or a monopolist insurer in 2018; a loss of insurers from 2016 to 2018, and a Republican state government. They were also…

Misleading Marketing of Non-ACA Health Plans Continued During COVID-19 Special Enrollment Period

Posted by

…48-year old “Jen” who takes a generic medication for high cholesterol and has an unspecified heart condition. Both were in a one-person household with an annual income of $20,000 and searching for new coverage because of a loss of employer coverage and a planned move to Texas. in an ACA plan with low premiums and out-of-pocket costs during the COVID-19…

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.